Chronic conditions strongly associated with physical inactivity Flashcards
What is the estimate for US adults with hypertension
77.9 million US adults >= 20 years of age and more than 1 billion world wide
Primary Hypertension…
What are the causes
Essential, Idiopathic
No definitive cause Genetic Alcohol Stress High fat diet High salt diet Physical inactivity Obesity
What does idiopathic mean
We dont know what caused the hypertension
Secondary Hypertension…
What are the causes
Develops through the manifestation of other medical problems
Genetic Renal Vascular Endocrine Over the counter medications
Pathophysiology of hypertension involves
High sympathetic nervous system activity
Structural narrowing of small arteries and arterioles
Reduction of capillaries
Arterial stiffness
Increased resistance to blood flow (TPR)
What detects a change in BP
Baroreceptors
Baroreceptors send a
Afferent signal to CNS
BP =
HR x SV x TPR
Cardiac output
HR x SV
What constricts to slow down and build resistance
Arteries and arterioles
What controls vasoconstriction
VSMC
Vascular smooth muscle cells
What are VSMC
Vascular smooth muscle cells
What are VSMC’s controlled by
Pre/post ganglion sympathetic neurones
What does pre ganglion sympathetic neurons release
What do post ganglion release
Acytle co enz
norephedrine
What has the overall control of BP
Kidneys
What is the special considerations for exercise and hypertension with those whose BP not controlled
Those whose BP not controlled (SBP >= 140 and/or DBP >= 90) should consult their physician prior to initiating an exercise program to determine if an exercise testing is needed
What is the special consideration for exercise and hypertension for individuals with SBP >=160 or DBP >=100 or with target organ disease
Must not engage in any exercise
No exercise testing prior to a medical evaluation and adequate BP management
Medically supervised symptom limited exercise test is recommended prior to engaging in an exercise program test
What do Beta Blockers do
Adverse effect on thermoregulatory function
Increase the hypoglycemia in certain individuals
Reduce submaximal and maximal exercise capacity primarily in patients without myocardial ischemia
Decreased submax and max HR
What do Antihypertensive medication such as alpha blockers, calcium channel blockers and vasodilators do
Sudden excessive reduction in post exercise BP = postexercise hypotension
Termination of the exercise should be gradual and the cool down period should be extended and carefully monitored until BP and HR return to near resting levels
What are beta blockers
What does it cause the heart to do
Target beta receptors in heart which stops NE and Ephedrine from binding and exciting the heart
Therefore slows down heart rate
Mechanism of Digoxin
Slows HR at atria to ventricle
Inhibition of sodium potassium adenosine triphosphatase
Mechanism of betablockers
Slow HR
Antagonists that block the receptor sites for Epi and NE on adrenergic beta receptors of SNS
Mechanism of calcium channel blockers
Slow HR
Reduce strength of cardiac muscle contraction
Prevent or reduce the opening of channels, not allowing Ca++ to get into cells
Mechanism of alpha blockers
Relax vascular smooth muscle cells, vasodilate
Reduce vascular resistance
Increase blood flow
A lack of calcium causes
Actin to not be exposed
Causes weaker contraction
What are the effects of exercise on hypertension
Average reduction of 5 to 10 mmHg in resting BP
Potential alterations:
Alteration in renal function
Decrease in plasma norepinephrine
Increase in circulating vasodilator substances
FITT recommendation for individuals with hypertension and AEROBIC
5-7 days
Moderate intensity
> = 30 min of continuous
Intermittent for 10 min bouts
Prolonged activities using large muscles
Estimated number of people in US with dyslipidemia
What is it
30% of people
Major risk factor for atherosclerotic CVD
Abnormal amount of lipids in the blood
Hyperlipidemias/hypercholesterolemia
What is the cause of dyslipidemia
High fat diet
Excess alcohol intake
Physical inactivity
What are the effects of exercise on dyslipidemia
Lower triglycerides - better skeletal muscle uptake
Higher HDL-c concentrations - with sustained aerobic exercise
Reduction in LDL and total cholesterol levels - weight/fat loss is required
Reduced postprandial lipemia
What are the special considerations due to drugs for dyslipidemia
Statin drugs (hydroxymethylglutaryl-CoA) reductase inhibitors are very effective for the treatment of dyslipidemia
What does statin drugs do
Statin therapy consistently improves survival by preventing myocardial infarction and stroke
What side effects of lipid lowering drugs may occur
May experience muscle weakness and soreness - Myalgia
May cause direct and severe muscle injury
Unusual or persistent muscle soreness when exercising while taking these medications
What is myalgia
Muscle weakness and soreness from taking lipid lowering drugs
FITT recommendation for individuals with dyslipidemia and AEROBIC
> = 5 days to max caloric expend
40 - 75%
30-60min to promote weight loss
50-60 min daily
Prolonged activities using large muscles
What is the estimated % of US adults with obesity
68% overweight/ obese
34% obese
6% extremely obese
What is the estimated % of US children with obesity
32%
What are the causes of obesity
Diet
Sedentary lifestyle
Genetics
Gut bacteria
What is the pathophysiology of obesity
Adipose tissue
Leptin
CNS/hypothalamus
FITT recommendation for individuals with obesity and AEROBIC
> = 5 days
Moderate 40 - 60%
Progress to vigorous >=60%
30 a day
150 a week
Increase to 60min a day
250-300 min a week
Prolonged activities using large muscles
Metabolic syndrome is the name for…
It is seen in _____ of the population
It increases….
There are differences in…
A group of risk factors that raise your risk for cardiovascular disease, diabetes and stroke
35% (US adult)
Increase with age
Difference in sex race and ethnicity
How many risk factors do you have to be diagnosed with to have metabolic syndrome
What risk factors are they
At least 3
Abdominal/central obesity
High fasting blood glucose - insulin resistance, prediabetes
Dyslipidemia - high serum triglyceride level, low serum HDL cholesterol level
High blood pressure
Miscroalbuminuria
Metabolic syndrome table??
?
What are the causes of metabolic syndrome
Aging
Genetics
Diet*
Sedentary lifestyle*
Insulin resistance*
Disrupted sleep
Stress
Mood disorders/psychotropic medication use
Excessive alcohol use
What are the effects of exercising on signs of metabolic syndrome
Weight loss/abdominal fat loss
Decrease in serum triglyceride, LDL and VLDL cholesterol levels
Increase in serum of HDL level
Reduction in blood pressure
Lower fasting glucose - improvement of insulin resistance
What is the exercise prescription/recommendation to reduce risk factors associated with CVD and DM (FITT-VP)
Frequency:
Minimum 3 days/week and most days of the week
Intensity:
Initial exercise training at moderate intensity (40-60% of VO2R)
Progress to more vigorous intensity (>= 60% VO2R)
Time:
Minimum of 150 min/week, or 30min/day
Type:
?
What is the exercise prescription/recommendation to reduce body weight/fat (FITT)
Frequency:
5 days/week and most days of the week
Intensity:
Moderate intensity
Time:
Minimum of 300min/week or 50-60 min/day
Progression of 60-90min/day
Type:
?
Recent findings show that to reduce overall metabolic syndrome severity…
Both diet control and exercise is required
Diet:
Hypocaloric diet
Low fat and high fiber diet
Mediterranean diet
Exercise:
Aerobic interval training
High/vigorous intensity interval training
High intensity endurance exercise mixed with resistance training
What is the bottom line
Prevalence:
Prevention:
Treatment:
The prevalence of the metabolic syndrome in the US increasing significantly
Prevention:
Healthy lifestyle - healthy diet and physical activity
Treatment:
Change lifestyle - lose weight and reduce risk factors from proper diet and exercise
Make flashcards on big flow chart?
?
If your SBP/DBP is 130/70mmHg, you are classified as _____ according to the new report from American Heart Association
Stage 1 Hypertension
Vasodilators have antihypertensive effects by lowering heart rate
False
Chronic exercise (through exercise training) decreases plasma norepinephrine levels in individuals with hypertension because it reduces sympathetic nervous system activity
True
Higher resistance on blood vessels could be due to constant contractions of vascular smooth muscle cells caused by higher sympathetic outflow
True
Exercise has positive effects on dyslipidemia by _____
Decreasing concentrations of LDL particles in bloodstream
Increasing HDL concentrations
High sympathetic nervous system activity increases vasodilation and total peripheral resistance
False
Following CDD4 recommendations for evaluation of physical functioning, at a minimum patients should be able to do these except
20 sit to stand repetitions in 30s
If you relate the intensity of physical activity and breathing, moderate activity at 3-6 METs is similar to the breathing which cannot pass the talk test
False
Gait speed can be placed into the perspective of requirements for various activities and outcomes
True
If your client’s HDL level is 45 mg/dL, his negative risk factor is absent neutral
True
If your patient has bilateral edema, it indicates that he/she may have lymphatic blockage
False
FITT recommendation for individuals with hypertension and RESISTANCE
2-3 days
60-70% 1 RM
Progress to 80% 1 RM
Older/novice individuals = 40-50% 1RM
2-4 sets, 8-12 reps
Resistance machine/free weights/body weight
FITT recommendation for individuals with hypertension and FLEXIBILITY
> = 2-3 days a week
Stretch to point of feeling discomfort
Hold static stretch for 10-30secs
2-4 reps
Static, dynamic and or PNF
FITT recommendation for individuals with dyslipidemia and RESISTANCE
2-3 days
Moderate 50-70% 1 RM
Progress to vigorous 70-85% 1 RM to improve STRENGTH
<50% 1 RM to improve MUSCLE ENDURANCE
2-4 sets, 8-12 reps for STRENGTH
<= 2 sets, 12-20 reps for MUSCLE ENDURANCE
Resistance machine/free weights/body weight
FITT recommendation for individuals with dyslipidemia and FLEXIBILITY
> = 2-3 days a week
Stretch to point of feeling discomfort
Hold static stretch for 10-30secs
2-4 reps
Static, dynamic and or PNF
FITT recommendation for individuals with obesity and RESISTANCE
2-3 days a week
60-70% 1 RM
Increase to enhance strength and muscle mass
2-4 sets of 8-12 reps
Resistance machines/free weights
FITT recommendation for individuals with obesity and FLEXIBILITY
> = 2-3 days a week
Stretch to point of feeling discomfort
Hold static stretch for 10-30secs
2-4 reps
Static, dynamic and or PNF
What is leptin
Hormone released from adipose tissue which controls the amount of food you can eat
What ethnicities are seen in men for metabolic syndrome
What about females
Hispanic and white
Hispanic and African American
